Intestinal Failure and Short Bowel Syndrome in Crohn’s Disease: A Systematic Review

Crohn's disease (CD) is an inflammatory, chronic and progressive disease that affects the digestive tract. Despite optimized drug therapy, the risk of multiple surgical interventions over the years is high, leading the patient to develop short bowel syndrome (SBS). Thus, adequate management in the postoperative period directly interferes with the long-term prognosis. Initially, most of these patients, due to hydro electrolytic disorders and absorptive incapacity inherent in SBS, will need parenteral nutritional support. According to the patient's residual digestive profile and according to nutritional management (oral, enteral, and/or parenteral), the intestine will evolve in its adaptive capacity. During this period, control agents are used for motility and intestinal secretion and, if necessary, GLP-2 agonists (intestinotrophic). In cases refractory to these treatments, we can still indicate surgical procedures to control motility, increasing intestinal length, and, finally, transplantation. CD is recurrent, and patients with SBS need a multidisciplinary approach with continuous monitoring to provide better intestinal rehabilitation and consequent quality of life

Major Meta-Analysis, Randomized Clinical Studies, and International Consensus on Serum Levels and Importance of Supplementing Vitamin D: State of the art

Introduction: Hypovitaminosis D is highly prevalent and constitutes a public health problem worldwide. It can affect more than 90% of individuals, depending on the population studied. Objective: To make a broad analysis of the world literature to compose the State of the Art on serum vitamin D levels and its adequate supplementation, to prevent and mitigate various diseases, based on randomized clinical studies, analysis, and latest international conferences and consensus. Methods: The present study followed a literary review of randomized clinical studies, meta-analysis, and the latest international consensus. Cochrane instrument was adopted to assess the quality of the included studies between 2015 and 2020. Major considerations and conclusion: Laboratory evaluation should be performed by measuring 25(OH)D, and the main groups of individuals at risk for vitamin D deficiency are the elderly, patients with osteoporosis, history of falls and fractures, obese, pregnant women, and infants. For patients with osteoporosis and increased risk of fractures, recommended that concentrations of 25(OH)D remain above 30 ng/mL for full benefits on the prevention of secondary hyperparathyroidism, decreased risk of falls. Special considerations must have taken to pregnant women and infants, in patients with chronic renal failure, obese patients, and those undergoing bariatric surgery. Several clinical studies and current meta-analysis have shown significant results with vitamin D supplementation in cardiovascular complications, diabetes, cancer, autoimmune diseases, cognitive function, among others, with doses above 30 ng/mL, reaching up to 70 ng/mL, and maintaining serum dosage at 50 ng/mL

Body Perception and Anorexic Behavior in Medical School Students: A Cross-Sectional Observational Study

Introduction: The concept of body image is defined as the subjective image about the forms and characteristics of the body itself, which integrates physical, mental, and emotional levels about this perception. Excessive concern with weight and body shape and the divinization of exaggerated thinness can lead to eating disorders, which are characterized as psychiatric diseases defined by changes in eating behavior, which mainly affects women, being a source of physical and psychological damage. One of the most common disorders is anorexia nervosa (AN). Objective: To analyze the body perception and anorexic behavior of students at a medical school in the interior of São Paulo. Methods: This is an observational, qualitative study to assess the body perception and anorexic behavior of university students at a medical school in the city of Catanduva-SP. The sample consisted of 141 students. To assess the perception of body image, the Kakeshita silhouette scale, and a visual analog scale were used. For the evaluation of the subjective component of the body image, a virtual questionnaire was applied by Google Forms on the evaluated components. The assessment of nutritional status considered the classification of the body mass index and the EAT-26 test. For statistical analysis, the Wilcoxon non-parametric test was used. Results: The students had an average age of 21.34 years ± 2.2 and an average height of 1.64 meters. The average of the real Body Mass Index (BMI) was 22.08 Kg/m², the perception of BMI was 26.40 Kg/m² and the desired BMI was 22.93 Kg/m², the last two being different statistically from the first. As for EAT-26, 73 students obtained a score greater than or equal to 21, which is considered a risky behavior for the development of AN. Conclusion: Most students have an altered perception of their body image since the perception of BMI is higher than the real BMI. In addition, it was noted, from the positive EAT-26, the existence of a high-risk behavior index for anorexia nervosa in the women in the sample. Thus, it is necessary to investigate the causes of the divergence between reality and looking at oneself in order to prevent such changes from becoming eating disorders

Obesity And Covid-19: A Descriptive Review

Introduction: According to data provided by the World Health Organization (WHO), 5,941,223 confirmed cases and 366,601 deaths had already been reported by May 31, 2020. Higher rates of infection, hospitalization, submission to the Intensive Care Units, and fatalities were attributed to obese patients. Objective: To gather the available data on obesity and SARS-CoV-2 infection. The study specifically covers combined pathophysiology and prognosis and will be updated until September 2020. Methods: This is a literature review study with a narrative-descriptive approach. The search was carried out in September 2020, with the totality of articles from that same year, when the pandemic of the new coronavirus was declared by the World Health Organization. Results: The search on the data platform resulted in 121 articles, of which 86 were classified as reviews and 35, systematic reviews, totaling 18 reviews and 7 systematic reviews at the end, with a total value of 16 articles with sufficient quality. Obesity is associated with increased severity of COVID-19 in the infected individual with this disease, due to the chronic inflammatory process, with high levels of pro-inflammatory leptin and a lower concentration of anti-inflammatory adiponectin, which causes a response delayed and inferior immune system. Conclusion: Individuals with this association have an easier time in the formation of possible clots, due to chronic inflammation and impaired fibrinolysis, which qualifies them as individuals of significant thrombogenic risk. Thus, individuals with obesity are an important risk group when considering its association with the disease of the new coronavirus

Chronobiology: Proper Feeding to Sleep Cycles

Chronobiology is the process that studies the biological rhythms of living beings, in which each organism has its own biological clock. Sleep is a state of unconsciousness, characterized by the active inhibitory process, and that has an important relationship with feeding, mainly due to the possibility of sleep privation increasing starvation through hormonal regulation. In addition, starvation can lead to obesity, contributing to the risk factors for chronic non-communicable diseases, such as high blood pressure, hypercholesterolemia, diabetes mellitus, cardiovascular diseases, and some forms of cancer. The cycle of bad sleep may cause direct health problems, such as the diseases mentioned above; and indirect, may result in traffic accidents, unemployment, and difficulties in interpersonal relationships, with the possibility of progressing to anxiety disorders.  This study aims to analyze whether there is a relationship between healthy eating and the standard of sleep quality, providing better performance of daily activities. For this study, the 133 participants answered 3 feeding records and, later, questionnaires on sleep quality (Pittsburgh Sleep Quality Index) in three moments. Considering the three questionnaires, there were no significant differences obtained by calculating the statistical tests, however, the analysis of the gross medians with the proposed score showed a strict relationship between sleep and food. In addition to the relationship between food and sleep quality, other factors such as stress and anxiety can contribute to hormonal dysregulation, thus changing the pattern of sleep quality of individuals

Observational-Epidemiological study on the use of drugs to treat obesity: A Brazilian profile of 520 answers

In a modern world, where day-to-day worry and stress prevails, along with an ever-increasing workday, care with diet is often overlooked and, combined with a sedentary lifestyle, increases obesity rates in all the world. The purpose of this work is to analyze society's view about the treatment of obesity with medications, comparing it with the treatment of other diseases, such as high blood pressure and diabetes. Through a questionnaire, on the internet, carried out from July to September 2020, with 14 multiple-choice questions answered by 520 people, 91.7% of the participants answered that obesity is a disease, however, 47.3% of people still think that the use of drugs for their treatment is not necessary and only 37.7% believe in the effectiveness of such a method. In addition, 26.2% believe that all obese people eat a high amount of food and practice little physical activity. As for the comparison with other diseases, 33.3% of the respondents believe that diabetes should be treated with medication and obesity should not, and 32.3% believe that hypertension should use this method and obesity should not. With such results, it was concluded that the society's view is still quite stigmatized regarding the treatment of obesity by drugs, which implies prejudice and the difficulty in adhering to this method by obese people and, with this, is the difficulty in reducing the rates obesity and all comorbidities related to it

The Ingestion and Perspective of Magnesium Consumption by Medicine Students: An Observational Brazilian Study

Magnesium is an important nutrient for the organism present in several enzymatic reactions. The reduced daily intake of this mineral (below 310 to 320 mg, for women, and 400 to 420 mg, for men) is associated with several chronic diseases. Thus, based on the hypothesis that medical students have a deficient intake of the mineral, this study sought to examine the intake of macronutrients by medical students at a college in the northwest of São Paulo and their thinking about the importance of the presence of the mineral of the diet. This research is a cross-sectional quali-quantitative study. The data used were obtained through a virtual questionnaire that contained several questions to identify gender, the notion of the importance of correct magnesium intake and the frequency of food consumption. The questionnaire was made available to academics between July and August 2020. The responses to the questionnaire were validated only after acceptance of the informed consent form. Thus, 147 responses were validated, with 92 responses from women and 55 from men. Then, from the amounts of magnesium present in food and the minimum and maximum frequencies of magnesium intake by students, the minimum (male 133.2 mg and female 128.5 mg) and maximum (male 232, 8 and female 229.5) of the daily magnesium intake by the students analyzed and their respective standard deviations, using these data, the Figure of the normal distribution for each type of daily average intake was plotted. Also, an opinion was obtained about the importance of magnesium intake on a scale of 1 to 5 (1 being irrelevant and 5 essential) and, from these data, it was observed that those who considered magnesium intake to be irrelevant (3 responses) presented a minimum and a maximum average (57.03 mg / day and 149.4 mg/day, respectively) of daily mineral intake below the 64 that considered it essential (140.06 mg/day and 238 mg / day) day, respectively). Finally, it is noted that the consumption of both sexes of the interviewees is close and both the maximum mean daily magnesium intake resides below the recommended amounts for daily consumption - mainly individuals of the sex but culino, who have a recommended intake value higher daily dose (400 to 420 mg/day) than females (300 to 310 mg). Thus, this data supports the initial hypothesis of the existence of a deficient daily consumption of magnesium by medical students, also, it can be related to a lower importance attributed to the presence of magnesium in the diet to a lower average daily intake

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans—anteaters, sloths, and armadillos—have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status